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Global
situation
Worldwide,
the exact number of people ending, attempting or thinking of ending their
lives is not known. Suicide is one of the leading causes of death across the
world, especially in the 15-35 year age group. As per WHO estimates, nearly
one million people will commit suicide during the first year of this millennium.
This amounts to an average of one death every 40 seconds and an attempt every
three seconds. Deaths recorded due to suicide across the world indicate only
the tip of the iceberg.
The
global rate of occurrence (new deaths per year) of suicide rose from 10 per
100 000 population in the 1950s to 18 per 100 000 during 1995 (Figure 1).
While it has declined in some countries, there has been a significant
increase in some developing countries, with a plateauing
off in other countries. Collectively, an upward trend is noticeable across
the world, which is a matter of concern.
It
is also known that more men complete suicide as compared with women, though
this might vary across countries (from equal to high rates). Globally, nearly
60% of these deaths are among young adults in their productive years of life.
This is a distinct change, as earlier, more suicides
were recorded among the elderly.
The various factors contributing to suicide in a country are determined by
the size of the population, age and sex distribution, sociocultural ethos,
extent of sociotechnological development,
availability of methods for suicide and intervention efforts.
Figure1:Global
Suicide Rates(per 100 100 population)
1950-1995
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From Indonesia…
Ms D, 20 years of age, was admitted to a private mental hospital
in February 2000, for a suicide attempt by injection of a poison. This was
her fourth such attempt in the last four years. Her mother had died when
she was 10 years old, and after that, she had refused to go to school and
used to be alone most of the time. Since July 2000, she had received
treatment, including psychiatric consultation and counselling
for her drug abuse problem. She is now more stable, cooperative, willing to
work and has made friends. She is confident, sure of herself and does not
feel lonely or have any thoughts of ending her life.
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Suicide
rates in SEAR Member Countries
Among the SEAR Member Countries, the suicide rates vary from 8 to
50 per 100 000 population. Some countries, such as India, Indonesia, Sri Lanka and Thailand, include suicides in their
health information systems, while others do not. In Indonesia, suicides are included in the
category of accidents. India and Sri Lanka record the highest number of
suicide rates (11 and 37 per 100 000 population respectively) and occupy
the 45th and seventh positions globally. Nearly 104 000 persons in India, 10 600 in Sri Lanka, 5 095 in Thailand and 2 548 persons in Bangladesh committed suicide (1997-1998)
as per official reports. Precise information from other countries of the
Region are not available for recent years.
In every country, suicide is reported to the police, whereas the health
sector conducts forensic examination for completed suicides and provides
care for the attempted ones. Deaths due to suicide are underreported to
avoid sociocultural stigma, escape police enquiries and legal harassment,
and benefit from the insurance sector. They are also misclassified as
accidents. Hence these official numbers are gross underestimates. Further,
the information related to attempted suicides is not compiled by any single
agency.
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Yogeeta
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Changing trends
in suicides in SEAR
Bangladesh
From
an average of 600 suicides per month during 1972-1988, the number of suicides
increased to 984 per month during 1992-1993. The overall national rates are
estimated to be 8 per 100 000 for the period 1972-1988 and 10 per 100 000
during 1992-1993, based on secondary sources. The total number of suicides
reported to the Forensic Medicine Department of Dhaka Medical College
indicates that suicides have increased from 12 per month in 1989 to 18 per
month in 1998. On an average, 15% of the total number of
autopsies have been associated with suicides. Within Bangladesh, focused studies from Jheneidah and Jessore districts
indicate an increasing trend of suicides from 29 per 100 000 in 1973 to 33
per 100 000 in 1985.
Yogeeta
Figure 2: Changing pattern of suicide in selected
countries of SEAR
(Rates per 100 000)
India
With
a rate of 11 per 100000 suicides per year, an increase from 6 per 100 000
(Figure 2) during the 1980s, India occupies the second highest rate
of suicides in the Region. When corrected for underreporting, these rates are
likely to be much higher. While 89000 persons committed suicide in 1995, the
number increased to 96 000 in 1997 and to 104 000 in 1998, an increase of 25%
compared to the previous year. During 1988-1998, suicides increased by a
staggering 33.7%. Major variations are noticed across the country, probably
related to reporting practices (Figures 3 and 4). Kerala
(29 per 100 000), Karnataka (21 per 100 000) and Tripura
as well as West
Bengal
(19 per 100 000) had the highest rates of suicide. Among the cities, Bangalore (17%), Mumbai (14%), Chennai
(11%) and Delhi (7.5%) accounted for nearly 50%
of the total suicides in the country.
Indonesia
Even
though nationwide data are not available, information indicates that suicide
is on the increase. Data from metropolitan Jakarta indicate that in just one
city alone, the number of suicides increased from 112 in 1996 to 146 in 1998
(Indonesia underwent a severe economic crisis during 1997-1998), with
corresponding rates of 1.6 and 1.8 per 100000, respectively. Interestingly, Jakarta, which was registering a decline
till 1996, showed a sudden increase during 1997-1998. There are substantial
geographical variations within Indonesia, e.g. suicide rate in Gunung Kidul is 9 per 100000,
compared with 1 per 100000 in metropolitan Jakarta.
Nepal
While
the exact incidence of suicide is not clearly known, death due to self-poisoning
was found to be the third leading cause of death during 1998 and 1999.
Sri Lanka
During
the past 15 years in war-torn Sri Lanka, it is estimated that nearly
50000 persons have been killed. Deaths due to suicide, in the same period,
are estimated to be 106000 -- twice the number due to war. As late as the
1950s, Sri Lanka had a low suicide rate of 6 per
100000. This rate doubled to 12 per 100000 by 1964 and increased to 19 per
100000 by 1969. This was followed by a sharp increase. The official estimates
for 1996 are 37 per 100000, making Sri Lanka one of the countries with the
highest number of suicides per unit of population (Figure 2). A study
revealed substantial underreporting and the real extent of the problem and
current rates are estimated to be 44-50 per 100000. Significantly, the
proportion of youth committing suicide increased from 33% in 1960 to 44% in
1980. Regional variations as in other countries are reported from Sri Lanka also (Figure 2). Suicides are
the fourth most frequent cause of death in hospitals in Sri Lanka.
Thailand
The
country recorded increasing rates from 1970 (4 per 100000) to 1980 (8 per
100000) with a gradual decline thereafter. The rates again increased to 6.7
in 1990, 7.6 in 1996, 7.0 in 1997, 8.3 in 1998 to 8.6 in 1999 (Figure 2).
This signifies that the declining trend noticed earlier has reversed, with an
upward surge from the 1990s.
It
is likely that the rates of suicide reported in all the SEAR countries are
underestimated as some deaths are never reported or are misclassified. In Sri Lanka, the extent of underreporting
was to the extent of 40%. Apart from overall national rates, it is important
to examine the problem at both regional and local levels, as some places
within each country are likely to have rates much higher than the national
rates (e.g. while the national rate was 7-10 per 100 000 in India, one of the
Indian cities had a rate of 22-33 per 100 000 during the 10-year period)
(Figure 3). This suggests the need for immediate national and local
preventive measures in the Member Countries of the Region.
Figure 3:Trends of Suicide in India(1987-1997)
Banglore (1989-1999)
Rates (per 100 000 population)
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